Preventing Tooth Decay and Gum Disease - Doctor Q&A

Tooth brushing alone isn't the most effective way to keep your teeth clean.

There is still 40% of your tooth surface that cannot be reached by toothbrushing alone.

Dental plaque can build up between the teeth where a toothbrush cannot get to. This is because the toothbrush bristles cannot reach the tight surfaces and narrow spaces in between the teeth.

Gaps occurring between teeth due to gum disease are also areas which the ordinary toothbrush cannot clean thoroughly.

That is why interdental (in-between teeth) cleaning aids – such as dental floss and interdental brushes are important.

Using interdental aids such as flossing and interdental brushes to clean gaps and surfaces in between teeth is one of the most important things you can do to change the health of your smile for the better.

In this ‘Ask the Specialist’ Q&A forum, don't miss the chance to ask Dr Chee Hoe Kit to find out more about cleaning between the teeth by asking questions such as:

• Why is it important to clean in between the teeth?
• How do I know if I should use an interdental cleaning aid?
• What is interdental cleaning and how do I do it properly?
• What happens if I do not floss my teeth?
• When’s the best time to floss?
• Should I brush or floss first?
• Can I rinse and reuse floss?
• How to use interdental brushes?
• How do I choose the correct interdental brush size?
• How do I know if I have poor gums?
• What treatment is there for gum disease?

Or any other question related to preventing tooth decay and gum disease! This Q&A is open for one month only!

Catch this video of Dr Chee Hoe Kit sharing on the importance of flossing, how to do it correctly and how to choose the different types of interdental cleaning aids.

Clinical Assistant Professor Chee Hoe Kit is a fully qualified and experienced gum specialist who works full-time in the National Dental Centre of Singapore as a Senior Consultant in the Periodontics Unit, Department of Restorative Dentistry.

He also leads the Dental Clinic at the Diabetes & Metabolism Centre in the Singapore General Hospital, a clinical service that provides periodontal screening and treatment in patients with diabetes.

Apart from gums, Clin Assist Prof Chee also treats patients with dental implants and its related surgical therapies.

He is also an educator with SingHealth Duke-NUS teaching postgraduate students in periodontology and a clinician-scientist doing research on periodontal health and its impact on diabetes mellitus and he has also given several talks on oral health and diabetes to the general public as well as to medical and dental clinicians.

1. Question by TL Koon

Hi Dr,

Kindly give a reply on the following:

a) How to use interdental brush properly?

b) How do I choose the correct interdental brush size?

c) When is the best time to use interdental brush?

d) Is it necessary to also use floss, besides interdental brush?

Thank you.

Answer by Clin Asst Prof Chee Hoe Kit

a) Place the interdental brush on the gumline between two teeth and insert it into the space between the two teeth by making small, rotating movements.

Push the brush portion gently all the way through and then pull it out once before rinsing with water and move on to the next space.

b) Different brands of interdental brushes may have different sizes or color codes with each other. Depending on the brand of interdental brush that you have chosen:

First look in the mirror and see the where the gap or space between 2 teeth is and roughly estimate the nearest size of the interdental brush for that space. Then insert the brush into the interdental space while it is close to the gums but do not force it through.

Start with the size you have initially chosen for that space and if it feels too “loose” between the 2 teeth,  work another size up until you could feel the bristles engage the teeth surfaces and the gum tissue.

The correct interdental brush should have a snug fit between the 2 teeth and the wire in the centre of the bristles shouldn’t touch the sides of the teeth or the gums. You will likely need to have more than 1 size of interdental brush for all the different gaps or spaces between the teeth.

To know how to choose the correct interdental brush size, you can also try checking out this video.

c) It is usually best to use interdental brushes after brushing your teeth before going to bed.

d) If you have extremely narrow gaps and tight contact areas between teeth which interdental brushes won’t fit in, then flossing is advised to clean those areas of the entire set of teeth.

2. Question by Thomas

Hi Dr,

a) How to use interdental brushes?

b) How do I choose the correct interdental brush size?

Thank you for your advice.

Answer by Clin Asst Prof Chee Hoe Kit

a) Place the interdental brush on the gumline between two teeth and insert it into the space between the two teeth by making small, rotating movements.

Push the brush portion gently all the way through and then pull it out once before rinsing with water and move on to the next space.

b) Different brands of interdental brushes may have different sizes or color codes with each other. Depending on the brand of interdental brush that you have chosen:

First look in the mirror and see the where the gap or space between 2 teeth is and roughly estimate the nearest size of the interdental brush for that space. Then insert the brush into the interdental space while it is close to the gums but do not force it through.

Start with the size you have initially chosen for that space and if it feels too “loose” between the 2 teeth,  work another size up until you could feel the bristles engage the teeth surfaces and the gum tissue.

The correct interdental brush should have a snug fit between the 2 teeth and the wire in the centre of the bristles shouldn’t touch the sides of the teeth or the gums. You will likely need to have more than 1 size of interdental brush for all the different gaps or spaces between the teeth.

To know how to choose the correct interdental brush size, you can also try checking out this video.

3. Question by Catherine

Hi Prof Chee,

How effective are water dental flosser? Can we replace thread floss with water flosser? Thank you.

Answer by Clin Asst Prof Chee Hoe Kit

Some research studies have demonstrated that the use of water dental flosser plus using the manual toothbrush is an effective oral care regimen for controlling gingivitis.

If you find that using the thread floss is difficult to reach all the interdental areas of your teeth and cost is not an issue, then you may replace thread floss with a water flosser device instead of using both.

However, toothbrushing is still essential regardless of whether you use any interdental cleaning aids.

4. Question by Phyllis

Hi Prof Chee,

a) Can use water flosser iso dental floss? Will dental floss cause the gum to recede n teeth move if not done correctly?

b) Can I use electric toothbrush for better gum health?

c) how soon can I brush my teeth after lunch/dinner?

d) is it good to use mouth rinse after flossing? Despite using floss n interdental brush, my teeth still hv plaque between the gaps ☹

Answer by Clin Asst Prof Chee Hoe Kit

a) Some research studies have demonstrated that the use of water dental flosser plus using the manual toothbrush is an effective oral care regimen for controlling gingivitis.

So yes, you may use the water flosser instead of the traditional string floss. If you use it correctly, the dental floss should not cause the gums to recede or the teeth to drift apart.

d) There is no harm in using mouth rinses after flossing. You will not be able to eliminate the plaque between the gaps as it will always form again as long there is teeth in the mouth.

However you should continue to brush the teeth and use interdental cleaning aids plus visit the dentist to advise you more on the plaque control of your teeth more carefully.

Ref: F26